RESUMEN
We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Cementación , Luxación de la Cadera/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Luxación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
The current study evaluates the 4- to 8-year results of 26 cemented femoral revisions with impaction allografting using a collared femoral component in cases of extensive femoral bone loss. Patients were followed prospectively and were evaluated at an average of 6.0 years after the allograft revision procedure. The average age at the time of surgery was 69.3 years. At final follow-up, 20 patients (20 hips) were living, and 6 patients (6 hips) were deceased. No femoral component rerevisions were performed for any reason in any patient, and none were radiographically loose at final follow-up. There was 1 subsided femoral component of <5 mm, 3 postoperative periprosthetic femoral fractures, and a greater trochanter nonunion rate of 32%. At the current follow-up interval, these cemented femoral revisions with impaction allografting have performed well with excellent clinical and radiographic durability in this difficult patient population. The prevalence of periprosthetic fracture is a significant concern. This study shows durable results using the impaction allografting technique in cases of severe bone loss.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Trasplante Óseo/métodos , Fémur/patología , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Cementación , Femenino , Fémur/cirugía , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Reoperación , Trasplante Homólogo , Resultado del TratamientoRESUMEN
BACKGROUND: In total hip arthroplasty, techniques for cementing the femoral component have changed over time. The purpose of the present study was to determine whether a cementing technique that includes use of a distal cement plug and retrograde filling of the femoral canal affects the fixation of the femoral component at a minimum of twenty years after the operation. METHODS: Between 1976 and 1978, the senior one of us (R.C.J.) performed 357 total hip arthroplasties with use of a Charnley flatback polished femoral stem and a contemporary cementing technique (insertion of a distal cement plug and retrograde filling of the femoral canal with cement) in 320 patients. The results after a minimum follow-up of twenty years were compared with those after 330 total hip arthroplasties performed, between 1970 and 1972, with the same femoral stem by the same surgeon with use of a hand-packing technique of cementing in 262 patients. The clinical and radiographic evaluation as well as the duration of follow-up were identical in the two groups. RESULTS: In the group managed with the contemporary cementing technique, six (1.8%) of the 336 hips that had not been lost to follow-up or revised because of infection or dislocation were revised because of aseptic loosening of the femoral component. Of the ninety-one hips in the eighty-two patients who were alive at a minimum of twenty years, five (5%) had a revision because of aseptic loosening of the femoral component. Only one hip was revised during the fifteen-to-twenty-year follow-up interval. (The revision was performed because of a fracture of the femoral component.) The rate of failure when radiographic signs of loosening were included was 4.8% (sixteen of 336 femoral components that had not been revised because of infection or dislocation) for the group managed with the contemporary cementing technique compared with 6.3% (twenty of 319 hips) in the group managed with the hand-packing technique; the difference was not significant (p = 0.40). Adequate filling of the femoral canal with cement was found to be associated with improved survival of the femoral component (p = 0.03). CONCLUSIONS: While no significant difference between the two cementing techniques could be identified, the ability to deliver adequate cement around the femoral component was more predictable with the contemporary cementing technique. In addition, the prevalence of loosening of the femoral component was low with use of either technique, a tribute to the Charnley flatback polished femoral component design.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/epidemiología , Satisfacción del Paciente , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estadísticas no Paramétricas , Análisis de SupervivenciaRESUMEN
BACKGROUND: Although cementless acetabular components are routinely used in revision hip surgery, few investigators have evaluated the retention and efficacy of these components in the long term. In the current study, the clinical and radiographic outcomes of a series of arthroplasties performed by one surgeon with a cementless acetabular component were assessed at a minimum of ten years. METHODS: From 1986 through 1988, sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients because of aseptic failure of one or both components of a prosthesis in which both components had been cemented. Twenty-eight patients (thirty-two hips) were alive at a mean of 12.9 years (range, 11.5 to 14.3 years) after the operation. In all of the patients, the acetabular component was revised to a porous-coated Harris-Galante component inserted without cement, and the femoral component was revised to an Iowa component affixed with contemporary cementing techniques. The hips were evaluated clinically and radiographically at a minimum of ten years subsequent to the index revision. No hips were lost to follow-up. RESULTS: None of the acetabular components required revision because of aseptic loosening. Two hips (3%) demonstrated radiographic evidence of aseptic loosening of the acetabular component. The polyethylene liner was exchanged during the follow-up period in eight hips. CONCLUSION: After a minimum of ten years of follow-up, cementless acetabular fixation in revision hip arthroplasty had produced durable results that were markedly better than those reported for acetabular fixation with cement.
Asunto(s)
Acetábulo , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Reoperación , Estadísticas no Paramétricas , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The purpose of this article is to evaluate the dislocations that occurred in a single surgeon practice over a 26 year period. After extensive research, the authors concluded that dislocation continues to occur long after the initial arthroplasty procedure. Patients should be aware that more than a quarter of dislocations occur 2 years following surgery. Use of modular 22 millimeter components were associated with the highest dislocation rate. These components should be used very cautiously. Constrained liners have helped decrease the dislocation rate following revision for dislocation.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación de la Cadera/etiología , Complicaciones Posoperatorias , Anciano , Humanos , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de TiempoRESUMEN
Regarding dislocation after total hip arthroplasty, prevention is worth an ounce of cure. The current authors evaluated dislocation after total hip arthroplasty during the 26-year practice of one surgeon to identify potential variables that can contribute to the prevention of dislocation. Between 1970 and 1996, dislocation after total hip replacement occurred after 7.2% of primary hip arthroplasty procedures (298 of 4164 primary hip replacements) and 11.2% of revision hip arthroplasty procedures (90 of 803 revision hip replacements). Significant findings included an increase in dislocation when 22-mm modular femoral heads were used and a decrease in dislocation after revision for dislocation when constrained liners were used. An additional finding was that 26% of first time dislocations occurred more than 2 years after surgery. Concerning prevention of dislocation, small head modular femoral components should be used cautiously, and constrained liners should be considered in complex revision cases. Patients should be counseled concerning the potential for dislocation many years after their arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Luxación de la Cadera/prevención & control , Anciano , Femenino , Estudios de Seguimiento , Luxación de la Cadera/etiología , Humanos , Masculino , Osteoartritis de la Cadera/cirugía , ReoperaciónRESUMEN
BACKGROUND: Although the LCS (low contact stress) rotating-platform mobile-bearing knee replacement has been used extensively, there have been few intermediate or long-term clinical and radiographic follow-up studies evaluating the device. The purpose of this study was to report the nine to twelve-year results of a consecutive series of patients who had a primary total knee replacement performed with this device. METHODS: Between November 1985 and November 1988, the senior author (R. C. J.) performed 119 consecutive total knee arthroplasties in eighty-six patients with LCS rotating-platform femoral and tibial components and a Townley all-polyethylene dome patellar component. All components were fixed with cement. The average age of the patients at the time of the operation was seventy years (range, thirty-seven to eighty-eight years). Fifty-two patients (seventy-six knees) were female, and thirty-four patients (forty-three knees) were male. The patients were evaluated with clinical knee ratings and radiographic analysis nine to twelve years following the knee replacement. RESULTS: At the time of the nine to twelve-year follow-up, sixty-four patients (eighty-six knees) were alive, eighteen patients (twenty-eight knees) had died, and four patients (five knees) had been lost to follow-up. Of the 114 knees in the eighty-two patients for whom the final outcome was known, none required a reoperation and none had a dislocation of the mobile-bearing prosthesis. For the forty-five patients (sixty-six knees) who returned for final clinical and radiographic follow-up examinations at nine to twelve years, the average clinical and functional Knee Society ratings were 30 points (range, 2 to 70 points) and 44 points (range, 0 to 80 points) preoperatively and 90 points (range, 63 to 102 points) and 75 points (range, 30 to 100 points) at the final follow-up evaluation. The average Hospital for Special Surgery knee rating was 57 points (range, 28 to 80 points) preoperatively and 84 points (range, 59 to 97 points) at the final follow-up evaluation. The average active range of knee flexion was from 0 degrees (range, 0 to 10 degrees) to 102 degrees (range, 15 to 120 degrees) at the final follow-up evaluation. Seven of the sixty-six knees were painful anteriorly. There was no periprosthetic osteolysis and no evidence of loosening on follow-up radiographs. CONCLUSIONS: After nine to twelve years of follow-up, the cemented LCS rotating-platform knee replacement was found to be performing well, with durable clinical and radiographic results.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Adulto , Anciano , Cementos para Huesos , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Radiografía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
BACKGROUND: This report presents the results of the senior author's initial twenty-five-year experience with the use of Charnley total hip arthroplasty with cement. The purpose of this paper was to evaluate the long-term results of total hip arthroplasty. METHODS: Between July 1970 and April 1972, the senior author (R. C. J.) performed 330 Charnley total hip replacements with cement using a hand-packing cement technique in 262 patients. Fifty-one patients (sixty-two hips) who were alive at least twenty-five years post-operatively were evaluated from a clinical standpoint with use of a standard-terminology questionnaire. The average age of this group at the time of surgery was fifty-six years (range, thirty-five to seventy-one years) compared with sixty-five years (range, twenty-one to eighty-nine years) for the entire group. All patients were evaluated for radiographic changes at the time of their most recent follow-up. Of the fifty-one patients (sixty-two hips) who were alive at least twenty-five years postoperatively, thirty-one (thirty-six hips) had a follow-up radiograph made at a minimum of twenty-five years after the surgery. The average duration of radiographic follow-up for the fifty-one patients was 22.7 years (range, two to twenty-seven years). RESULTS: Of the sixty-two hips in the fifty-one patients who were alive at least twenty-five years postoperatively, fourteen (23 percent) had been revised. Three (5 percent) had the revision because of loosening with infection; eleven (18 percent), because of aseptic loosening; and none, because of dislocation. The prevalence of revision due to aseptic loosening of the acetabular component in all 316 hips (excluding those that were lost to follow-up or that were revised for infection or dislocation) was 6 percent (eighteen hips), whereas the prevalence in the fifty-nine hips (excluding the three revised for infection) in the patients who were alive at least twenty-five years after the arthroplasty was 15 percent (nine hips). The prevalence of revision because of aseptic loosening of the femoral component in all 316 hips was 3 percent (nine hips), and the prevalence in the fifty-nine hips in the living patients was 7 percent (four hips). In the group of living patients, osteolysis occurred in Gruen zone 1 or 7 in thirty-three hips and in Gruen zones 2 through 6 in two hips. Ballooning acetabular osteolysis occurred in five hips. Of the 327 hips for which the outcome was known after a minimum of twenty-five years, 295 (90 percent) had retained the original implants until the patient died or until the most recent follow-up examination. Of the sixty-two hips in patients who lived for at least twenty-five years after the surgery, forty-eight (77 percent) had retained the original prosthesis. CONCLUSIONS: Our follow-up study at twenty-five years following Charnley total hip arthroplasty with cement demonstrates the durability of the results of the procedure. These results should provide a means for comparison with the results of newer cementing techniques as well as those associated with newer cemented and cementless hip designs.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Anciano , Cementos para Huesos , Cementación/métodos , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera/estadística & datos numéricos , Humanos , Masculino , Diseño de Prótesis , Falla de Prótesis , Radiografía , Reoperación/estadística & datos numéricos , Factores de TiempoRESUMEN
One hundred forty Marmor cemented unicompartmental knee replacements were inserted in 103 patients between 1975 and 1982. Fifty-two patients were women and 51 were men. One hundred twenty-five were medial compartment knee replacements and 15 were lateral knee replacements. At minimum 15 year followup 34 patients with 48 knee replacements were living; only four patients with four knee replacements were lost to followup. Average preoperative and final followup Hospital for Special Surgery knee scores were 57 and 82 points, respectively for the knees of living patients. Average preoperative and final followup Knee Society clinical and Knee Society functional scores were 31 and 42, and 85 and 71 points, respectively. For all knees, 10.2% (14 knees) were revised [4.4% (six knees) for tibial loosening, 5.1% (seven knees) for disease progression, and .7% (one knee) for pain]. For patients living 15 years, 12.5% (six knees) were revised [2.1% (one knee) for tibial loosening, and 10.4% (five knees) for disease progression]. Revision for failure of fixation of these unicompartmental replacements was comparable with that reported for fixed bearing total knee replacement. Disease progression (46%; 62 of 136 knees) and tibial subsidence with wear (10.4%; 15 of 136 knees, five of which required revision) were the major long term problems in this group of patients.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/cirugía , Cementación , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Dimensión del Dolor , Falla de Prótesis , Radiografía , Reoperación , CaminataRESUMEN
BACKGROUND: The purpose of the present study was to compare the results associated with two different surface finishes (bead-blasted and grit-blasted) for Iowa femoral components used in total hip arthroplasties performed between January 1979 and June 1991 in patients who were less than fifty years old. METHODS: Between January 1979 and December 1985, thirty-six primary total hip replacements were performed in twenty-five patients with insertion of a bead-blasted Iowa femoral component (average surface roughness, 0.8 micrometer) with cement and insertion of a titanium-backed acetabular component (thirty-five hips) or non-metal-backed acetabular component (one hip) with cement. Between January 1986 and June 1991, forty-five primary total hip replacements were performed in thirty-seven patients with use of a precoated grit-blasted Iowa femoral component (average surface roughness, 2.1 micrometers) and a Harris-Galante-I porous ingrowth acetabular component (forty-one hips) or an Osteonics component (four hips). The only change in the design of the femoral component (other than the surface finish) between the two consecutive series was the addition of polymethylmethacrylate precoating to the proximal third of all forty-five grit-blasted stems and modularity of the femoral head of the last eight grit-blasted stems. RESULTS: No hip was lost to follow-up. The duration of radiographic follow-up of the hips treated with the bead-blasted component averaged 11.3 years (range, ten to sixteen years) postoperatively, whereas that of the hips treated with the precoated grit-blasted component averaged 8.2 years (range, five to eleven years). Two (6 percent) of the bead-blasted femoral components were revised because of aseptic loosening compared with eight (18 percent) of the precoated grit-blasted components. Four bead-blasted components (11 percent) were either radiographically loose or were revised because of loosening compared with eleven precoated grit-blasted components (24 percent). Kaplan-Meier survivorship curves evaluated with log-rank analysis revealed that the bead-blasted Iowa femoral components were revised because of aseptic loosening (p = 0.0184) and were radiographically loose (p = 0.0068) less often than the precoated grit-blasted Iowa femoral components. CONCLUSIONS: The findings of the present study have led the senior ones of us to resume using femoral components with a polished surface and fixed with cement.
Asunto(s)
Materiales Biocompatibles Revestidos , Prótesis de Cadera , Polimetil Metacrilato , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Factores de Tiempo , Resultado del TratamientoRESUMEN
In 37 patients, 45 total hip replacements were performed using contemporary cementing techniques, an uncemented Harris-Galante I acetabular component and a cemented precoated Iowa femoral component in patients under the age of 50 at the time of their surgery; 36 patients with 43 hybrid hips were living, 1 patient with 2 hybrid hips was decreased. No patients were lost to follow-up. At 5- to 10-year follow-up, eight hips were revised for aseptic loosening. No acetabular components, and eight femoral components (18%) were revised for aseptic loosening. When looking at radiographic results, including revision as well as those components that were probably or definitely loose on radiographs, 0 acetabular components and 11 femoral components (24%) were radiographically loose. These results demonstrate the excellent durability of the uncemented Harris-Galante acetabular component in the younger patient. However, the Iowa grit-blasted methyl methacrylate precoated femoral component had a magnitude increase in the prevalence of revision for aseptic femoral loosening when compared to the senior author's long-term Charnley results in this age group. The authors attribute the failure to the rough surface finish applied to the femoral component. However, the polymethyl methacrylate proximal precoating and the femoral component design may also contribute to the femoral failures.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Adulto , Cementos para Huesos , Cementación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Polimetil Metacrilato , Diseño de Prótesis , Falla de Prótesis , Factores de TiempoRESUMEN
We evaluated the results twenty to twenty-five years after ninety-three consecutive, nonselected Charnley total hip arthroplasties performed with cement by the senior one of us in sixty-nine patients who were less than fifty years old at the time of the procedure. Seventy of the seventy-two hips in the living patients were followed radiographically for at least twenty years. Twenty-seven hips (29 per cent) had a revision or a resection of the prosthesis during the follow-up period. The revision or the resection was performed because of aseptic loosening in twenty-one hips (23 per cent), infection in four (4 per cent), dislocation in one (1 per cent), and fracture of the femur in one. Eighteen acetabular components (19 per cent) and five femoral components (5 per cent) were revised because of aseptic loosening, and an additional fourteen acetabular components (15 per cent) and seven femoral components (8 per cent) demonstrated definite or probable radiographic loosening. The present study demonstrates the long-term durability of total hip arthroplasty performed with cement in an active population of patients. The fixation of the femoral component was found to perform better than that of the acetabular component at twenty to twenty-five years after the procedure.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Adolescente , Adulto , Factores de Edad , Femenino , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Osteólisis , Dolor Postoperatorio , Satisfacción del Paciente , Falla de Prótesis , Radiografía , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
Fifty-six constrained acetabular components were placed, between April 1988 and February 1993, in fifty-five patients who had had recurrent dislocations (average, six dislocations; range, two to twenty dislocations) of the femoral component after a previous total hip arthroplasty. All patients had additional factors contributing to the instability of the implant, including absence or disruption of the abductor mechanism, poor health, mental retardation, confusion, and Alzheimer disease. One patient was lost to follow-up. The remaining patients were followed clinically for a minimum of three years (average, sixty-four months; range, thirty-seven to ninety-seven months) or until the time of death. During the follow-up interval, only two (4 per cent) of the fifty-five patients had a subsequent dislocation. The use of this type of component should be considered for patients who have recurrent dislocation if other treatment modalities are unlikely to be effective.
Asunto(s)
Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Acetábulo , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/etiología , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Diseño de Prótesis , Falla de Prótesis , Radiografía , Recurrencia , Reoperación , Estudios RetrospectivosRESUMEN
Between April 1988 and February 1993, 101 constraining acetabular components were implanted into 98 patients. One patient was lost to followup at 8 months. Otherwise, all patients were observed until death or for at least 2 years minimum followup. The average clinical followup for the living patients was 61 months (range, 24-97 months). Indications for the use of the constrained acetabular components were recurrent dislocation (an average of six dislocations, range 2-20) in 56 cases, intraoperative instability in 38 cases, and neurologic impairment in seven cases. For the entire group there were four cases of recurrent dislocation or failure of the component (4%). For the cases where this component was used for recurrent dislocation, 96% (54 of 56 cases) had no additional dislocations. Radiographically, at this short term followup, there was no evidence of an increased incidence of femoral or acetabular component loosening. The authors recommend judicious use of this component as a salvage measure for desperate cases of hip instability during or after total hip arthroplasty.
Asunto(s)
Acetábulo , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Falla de Prótesis , Terapia Recuperativa/instrumentación , Terapia Recuperativa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Luxación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Diseño de Prótesis , Radiografía , Recurrencia , Reoperación/instrumentación , Reoperación/métodosRESUMEN
The durability of cemented and hybrid total hip arthroplasty in the young adult was evaluated. A consecutive series of primary cemented total hip arthroplasties performed between 1970 and 1976, and a consecutive series of primary hybrid total hip arthroplasties performed between 1986 and 1991, were evaluated for revision and radiographic loosening of the components. All patients were younger than 50 years of age at the time of surgery and all surgery was performed by one surgeon. At minimum 20 years followup of the cemented group (93 hips in 69 patients) 22% of hips (21 hips) were revised for aseptic loosening (5% of femoral components, five hips, and 19% of acetabular components, 18 hips). At 5- to 10-year followup of the hybrid group (45 hips in 37 patients) 18% of hips (eight hips) were revised for aseptic loosening (18% of femoral components, eight hips, and 0% of acetabular components, 0 hips). Although the cemented femoral component used in the hybrid series showed a marked increase in revision and loosening compared with the cemented series, the excellent fixation obtained with uncemented acetabular components has encouraged the authors to continue the use of hybrid fixation in the young adult. However, the femoral component has been modified to incorporate a polished surface finish and a stem geometry similar to the Charnley flat back prosthesis used in the cemented series.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Adulto , Cementación , Prótesis de Cadera , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios RetrospectivosRESUMEN
We evaluated the rates of volumetric wear and the patterns of wear of 128 acetabular components retrieved during an autopsy or a revision operation between one and twenty-one years after total hip arthroplasty. Twenty-two all-polyethylene components were retrieved at autopsy from hips that had been functioning well at the time of death (Group A). The remaining 106 components--eighty-four all-polyethylene components (Group B) and twenty-two metal-backed components (Group C)--were retrieved during revision operations. All 128 components had been inserted with cement. The mean rate of volumetric wear, determined directly with a fluid-displacement method, was thirty-five cubic millimeters per year (range, eight to 116 cubic millimeters per year) for Group A, sixty-two cubic millimeters per year (range, eight to 256 cubic millimeters per year) for Group B, and ninety-four cubic millimeters per year (range, twelve to 284 cubic millimeters per year) for Group C. Multivariate regression analysis showed a significant relationship (p < 0.05) between the size of the femoral head and the calculated mean annual rate of volumetric wear. The rate of volumetric wear was highest in association with thirty-two-millimeter femoral heads and lowest in association with twenty-two-millimeter heads; according to linear regression analysis, this represented a 7.5 per cent increase (Group A) or a 10 per cent increase (Group B) in the rate of wear for every one-millimeter increase in the size of the head. Linear regression analysis also showed a significant relationship between the duration that the implant had been in situ and the rate of wear (p < 0.05), with the rate being highest initially after the operation and decreasing with an increasing duration in situ. With the numbers available, the patient's age and gender and the side of the arthroplasty did not have a significant relationship to the annual rate of volumetric wear. Increased thickness of the polyethylene was related to a decreased rate of wear (p < 0.05) in the group of metal-backed components, which had a 25 per cent increase in the rate of wear for every one-millimeter decrease in thickness, but not in the other groups. The estimated median annual rates of wear, after adjustment of confounding variables to a hypothetical constant set of median values for the parameters (duration in situ, 132 months; diameter of the femoral head, twenty-six millimeters; and thickness of the polyethylene, eight millimeters), were significantly different among the three groups of components (p < 0.05). Histological evaluation of the worn surfaces showed the predominant mechanisms of wear to be abrasion and adhesion rather than fatigue-cracking or delamination. The highly worn areas were polished to a glassy finish on gross examination, but scanning electron microscopy showed numerous multidirectional scratches along with fine, drawn-out fibrils with a diameter of one micrometer or less oriented parallel to each other. These fibrils are the most likely source of submicrometer wear particles. Thus, wear appeared to occur mostly at the surface of the components and to be due to large-strain plastic deformation and orientation of the surface layers into fibrils that subsequently ruptured during multidirectional motion.
Asunto(s)
Prótesis de Cadera , Polietilenos , Acetábulo , Adulto , Anciano , Femenino , Humanos , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Falla de Prótesis , Análisis de Regresión , Reoperación , Factores de TiempoRESUMEN
Three hundred and fifty-seven consecutive Charnley total hip arthroplasties were performed in 320 patients with use of a so-called second-generation technique of cementing between July 1976 and June 1978. This technique includes use of a distal femoral intramedullary cement plug, hand-mixing of the cement, and use of a cement gun to deliver the cement into the femoral canal in a retrograde fashion. At the time of the latest follow-up evaluation, a minimum of fifteen years after the arthroplasty, 130 patients (142 hips) were still alive, 189 patients (214 hips) had died, and one patient (one hip) had been lost to follow-up. A radiograph was made for 116 (82 per cent) of the 142 hips in the 130 surviving patients. Of the 356 hips that had not been lost to follow-up, thirty-three (9 per cent) had had a revision and two (1 per cent), a Girdlestone resection arthroplasty during the follow-up period. Nineteen hips (5 per cent) were revised because of aseptic loosening of the femoral or acetabular component, or both (two hips); seven (2 per cent), because of loosening with infection; and seven (2 per cent), because of dislocation. The two resection arthroplasties were performed because of loosening with infection; both were done in patients who died before the time of the latest follow-up evaluation. Of the 142 hips in the 130 patients who were alive at a minimum of fifteen years, twenty-two (15 per cent) had been revised: fifteen (11 per cent), because of aseptic loosening; three (2 per cent), because of loosening with infection; and four (3 per cent), because of dislocation. Revision of the femoral component because of aseptic loosening (excluding components that were revised because of dislocation or infection) was performed in four (1 per cent) of the entire series of 356 hips and in three (2 per cent) of the 142 hips in the 130 patients who survived for at least fifteen years. Two of the 356 hips and two of the 142 hips had aseptic loosening of the acetabular as well as the femoral component at the time of the revision. Loosening of the femoral component, defined as aseptic loosening leading to revision or as definite or probable radiographic loosening, occurred in ten (3 per cent) of the 356 hips and in six (5 per cent) of the 116 hips for which radiographs were made at a minimum of fifteen years. The acetabular component was revised because of aseptic loosening in seventeen (5 per cent) of the entire series of 356 hips and in fourteen (10 per cent) of the 142 hips in the 130 patients who survived for at least fifteen years. The acetabular component loosened without infection in forty-one (12 per cent) of the 356 hips and in twenty-six (22 per cent) of the 116 hips for which radiographs were made at a minimum of fifteen years. In two of these patients, the femoral component was also revised. Thus, of the entire series of 356 hips, two had a revision of the femoral component alone because of aseptic loosening; fifteen, a revision of the acetabular component alone; and two, a revision of both components. Of the 142 hips in the 130 patients who survived for at least fifteen years, one was revised for loosening of the femoral component alone; twelve, for loosening of the acetabular component alone; and two, for loosening of both components. These findings demonstrate long-term durability of fixation of the femoral component but less reliable fixation of the acetabular component, even when the surgeon is experienced and improved techniques of cementing are used.
Asunto(s)
Cementación/métodos , Prótesis de Cadera/métodos , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Articulación de la Cadera/fisiología , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Osteólisis , Satisfacción del Paciente , Falla de Prótesis , Infecciones Relacionadas con Prótesis , Rango del Movimiento Articular , Reoperación , Resultado del TratamientoRESUMEN
The senior authors' initial experience with primary hybrid hip replacement in patients with osteoarthritis was studied to evaluate the efficacy of the procedure. Hybrid total hip arthroplasty (uncemented Harris-Galante acetabular component and cemented Iowa precoated femoral component) was performed in 131 consecutive, nonselected hips in 118 patients with the diagnosis of primary osteoarthritis. Followup was performed at 8 to 9 years after the procedure. The average age at the time of the procedure was 68 years (range, 45-87 years). There were 50 men (55 hips) and 68 women (76 hips). At final followup 19 patients (22 hips) had died. The femoral component had been revised for aseptic loosening in 8 hips (6.1%). One additional hip showed definite radiographic loosening. Hence, the prevalence of radiographic femoral failure was 6.9% (9 hips). No acetabular component had been revised for aseptic loosening and no acetabular component had migrated. The senior author continues to perform hybrid total hip arthroplasty in all patients with primary osteoarthritis. However, design modifications have been made in the femoral component that is used.
Asunto(s)
Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Radiografía , Reoperación , Resultado del TratamientoRESUMEN
Sixty-one consecutive so-called hybrid revision total hip arthroplasties were performed in fifty-five patients by one surgeon, from 1986 through 1988, for mechanical failure of a cemented total hip prosthesis. In all of the patients, the acetabular and femoral components were revised to a porous-coated Harris-Galante acetabular component inserted without cement and an Iowa femoral component inserted with cement. Contemporary cementing techniques were used, but structural bone graft was not. The over-all prevalence of repeat revision for aseptic loosening was 0 per cent for the acetabular components and 3 per cent (two hips) for the femoral components. In addition, 2 per cent (one) of the acetabular components and 5 per cent (three) of the femoral components demonstrated radiographic evidence of loosening. In the forty-three patients (forty-nine hips) who were alive at an average of seventy-four months (range, sixty to ninety-five months) after the revision, none of the acetabular components and 2 per cent (one) of the femoral components were revised again for aseptic loosening. An additional 2 per cent (one) of the acetabular components and 6 per cent (three) of the femoral components were radiographically loose. Ninety-eight per cent (forty-one) of the forty-two living patients (98 per cent [forty-seven] of the forty-eight hips) who had a clinical examination at least five years after the revision had increased function; 90 per cent (thirty-eight) of these patients (forty-four [92 per cent] of the hips) were satisfied with the result. The group that had a hybrid revision was compared with a group of seventy patients (seventy-four hips) who had had a revision total hip arthroplasty with use of contemporary cementing techniques for both components. These revisions had been performed by the same surgeon, before he performed the hybrid revisions, and the prevalence of repeat revision of the acetabular component was 7 per cent (five hips) and that of the femoral component was 4 per cent (three hips). In addition, 16 per cent (twelve) of the acetabular components and 3 per cent (two) of the femoral components were radiographically loose. The comparison group was not a consecutive series, as only the patients who had had radiographs made five to eight years after the revision were evaluated. In the fifty-two such patients (fifty-six hips) who were alive at five years after the revision with cement (average duration of radiographic follow-up, seventy-seven months; range, sixty to ninety-nine months), 9 per cent (five) of the acetabular components and 5 per cent (three) of the femoral components were revised again for aseptic loosening. An additional 21 per cent (twelve) of the acetabular components and 4 per cent (two) of the femoral components were radiographically loose. The results of the present study demonstrated a significant improvement (p = 0.0001) in the survival of the acetabular component of so-called hybrid revision total hip arthroplasties compared with that of revision total hip arthroplasties with cement performed by the same surgeon and followed for a comparable period.
Asunto(s)
Prótesis de Cadera/métodos , Acetábulo , Adulto , Anciano , Anciano de 80 o más Años , Cementación , Femenino , Fémur/diagnóstico por imagen , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Radiografía , Factores de TiempoRESUMEN
A prospective, comparative study of epineurotomy as an adjunctive procedure to transverse carpal ligament release for the treatment of carpal tunnel syndrome was conducted. Eighty-six patients with 117 involved hands were entered into the study. After entry, all patients completed an extensive preoperative questionnaire, a detailed physical examination, and preoperative neurophysiologic testing. Seventy-five hands were followed for a minimum of 24 months. The operative findings were similar between the group of those undergoing epineurotomy and the group that did not undergo epineurotomy. Postoperatively the twopoint discrimination values for all fingers averaged 5.3 mm and 5.15 mm, respectively, for the epineurotomy and nonepineurotomy groups. The physical findings, neurophysiologic findings, and patient perceptions of outcome after surgery were similar. It was concluded that the study data do not support the use of epineurotomy as an adjunctive procedure during carpal tunnel release.